Alopecia areata nail abnormalities L63.8

Nail involvement in cases of severe alopecia areata; rarely occurs in isolation. 

Nail changes are a common accompanying feature of alopecia areata (AA) and represent a significant cause of cosmetic and functional impairment. The following forms of nail dystrophy may occur with varying frequency:

• Trachyonychia
• Nail pitting: According to the literature, nail pitting occurs in 30–60% of patients with alopecia areata. In comparison, in a large non-alopecic control group (n = 1,423 older schoolchildren), nail pitting occurred in only 8.6% of cases (Klingmüller G et al. 1955).
• Erythronychia lunularis (red spots in the lunula): Erythronychia lunularis is a rarely described nail sign in alopecia areata, particularly in severe forms of the disease. However, it is not disease-specific and can also occur in other dermatological and systemic conditions. It must be distinguished from longitudinal erythronychia, which is characterized by striped red changes in the nail plate. 
• Onycholysis
• Leukonychia(punctate)

Rough, dull, opaque nail plate; tiny indentations; longitudinal ridges. 

Spongiosis, partly spongiotic vesicles, lymphocytic exocytosis.

Twenty-Nail Dystrophy

1. Chelidze K et al. (2018) Nail changes in alopecia areata: an update and review. Int J Dermatol 57:776-783.
2. Klingmüller G et al. (1955) Nail pitting and its familial clustering in alopecia areata. Arch Klin Exp Dermatol 201: 574–580.
3. Shakoei S et al. (2024) Clinical and demographic characteristics associated with nail involvement in alopecia areata: A cross-sectional study of 197 patients. Health Sci Rep 7:e2020.
4. Tosti A et al. (1994) Prevalence of nail abnormalities in children with alopecia areata. Pediatr Dermatol 11:112–115.